Self-gated cardiac magnetic resonance perfusion imaging compared with X-ray angiography: a pilot study
© Harrison et al; licensee BioMed Central Ltd. 2012
Published: 1 February 2012
Cardiovascular Magnetic Resonance (CMR) stress perfusion is an effective noninvasive diagnostic clinical tool when combined with late gadolinium enhancement imaging (LGE) for evaluation of ischemia, infarct, and cardiac prognosis. Good ECG-gating is essential to the commonly used perfusion sequences, but ECG-gating is problematic in obese patients, high field magnetic fields, and patients with arrhythmias. We describe a rapid radial-based self-gated (SG) perfusion acquisition for detection of perfusion defects and compare this to LGE and X-ray coronary angiography (XCA) in the detection of infarction or ischemia.
In 5 patients (4 males, 1 female, 4 with paroxysmal atrial fibrillation, and 1 in atrial fibrillation during the CMR scan) with known or suspected obstructive coronary artery disease, a CMR study was performed including cine imaging, dynamic stress perfusion with adenosine, rest perfusion, and LGE. Gadoteridol (Prohance) 0.075 mmol/kg was injected for stress and subsequently rest perfusion and 230 time frames of 5 slices each were acquired over a minute (regardless of heartrate). A saturation recovery radial turboFLASH sequence was used without regard to the ECG. The images were reconstructed with an iterative compressed sensing method. Four out of the 5 patients had XCA. The SG perfusion images were qualitatively analyzed by 2 expert readers and correlated with LGE and XCA.
Self-gated radial-based dynamic MRI perfusion correlates with XCA in patients with ischemia, infarct, and normal coronary arteries. This technique may be particularly useful in patients with irregular heart rhythms such as atrial fibrillation where detection of ischemia is difficult. Future studies of SG sequences in a larger population of gating problematic patients are needed to determine sensitivity and specificity.
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